Jobs
DEMOGRAPHICS
Last Name
First Name
Full Middle Name
Home Telephone
POSITION(S) APPLYING FOR
Position No.
Job Title
Position No.
Job Title
Position No.
Job Title
Position No.
Job Title
Applying For:
Full Time
Part Time
Per Diem
Temporary
1. Are you currently authorized to work in the United States?
Yes
No
2. Are you willing to work overtime, if required?
Yes
No
3. Are you willing to perform "On Call" duty, if required?
Yes
No
4. Are you willing to work Saturdays, Sundays, and/or holidays?
Yes
No
5. Do you have a valid drivers license?(Requierd for some positions)
Yes
No
6. Has your driver license been suspended or revoked in the last three years?
Yes
No
7. Have you ever been covicted of a felony or 1st degree misdemeanor?
Yes
No
Have you ever worked here before?
No
Yes
List any relatives currently working here?
Name
Relation
Dept.
Name
Relation
Dept.
EMPLOYMENT HISTORY
Present or Last Employer
Address
Dates of Employment (M/Y)
Job Title
Duities
EDUCATION
High School Name
Did you Graduate
If G.E.D date received
yes
No
School Location [City, (County), State]
Technical/Malitary School
Did you Graduate
Degree, Diploma, Cert.
yes
No
College/University
School Location [City, (County), State]
Dates of Attendance
Major
Degree Recieved
Main Campus
1041 45th Street
West Palm Beach, Florida 33407
561.383.8000
Glades Services
406-408 SE Martin Luther King, Jr. Blvd.
Belle Glade, Florida 33430
561.993.8080
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